﻿@{
    ViewBag.Title = "ncxmr";
}
<!DOCTYPE html>
<html>
<head>
    <meta name="viewport" content="width=device-width" />
    <title>脑出血</title>
    <link rel="stylesheet" href="~/Scripts/ligerUI/skins/Aqua/css/ligerui-all.css" />
    <link rel="stylesheet" href="~/Scripts/ligerUI/skins/ligerui-icons.css" />
    <link rel="stylesheet" href="~/Scripts/ligerUI/skins/Gray/css/all.css" />
    <link rel="stylesheet" href="~/Content/css/common.css" />
    <link rel="stylesheet" href="~/Scripts/laydate/theme/default/laydate.css" />
    <script src="~/Scripts/jquery-1.10.2.min.js"></script>
    <script src="~/Scripts/jquery.form.js"></script>
    <script src="~/Scripts/ligerUI/js/ligerui.all.js"></script>
    <script src="~/Scripts/laydate/laydate.js"></script>
    <script src="~/Scripts/LiftEffect.js"></script>
    <script src="~/Scripts/common.js?v=@DateTime.Now.ToString("yyyyMMdd")"></script>
    <script src="~/Areas/StrokeCenter/Scripts/Ncxmr.js?v=@DateTime.Now.ToString("yyyyMMddHH")"></script>
    <style>
        body{overflow-x:auto;margin:5px;min-width:900px;}
	.radio_label{display:inline-block;width:auto;height:22px;background:url(/content/images/radiobutton.png) no-repeat;background-position:-13px -16px;text-indent:22px;line-height:22px;}
	.radio_label:hover{background-position:-13px -116px;}
	input[type=radio]{width:0;}
	.checkbox_label{display:inline-block;width:auto;height:22px;background:url(/content/images/checkboxbutton.png) no-repeat;background-position:-13px -16px;text-indent:22px;line-height:22px;}
	.checkbox_label:hover{background-position:-13px -116px;}
	.checked{background-position:-13px -216px;}
	.checked:hover{background-position:-13px -216px;}
	input[type=checkbox]{width:0;}
    </style>
</head>
<body>
    <form method="post" id="formSubmit">
        <div class="l-loading" style="display: none;" id="pageloading">
        </div>
        <div class="topPosition">
            <div style="float:left;font-size:13px;">
                <div style="float:left; margin-left:20px;">
                    手术类型：脑出血
                </div>
            </div>
            <div style="float:right;margin-right:10px;">
                <input type="hidden" id="txtPIId" value="" />
                <input type="hidden" id="txtAIId" value="" />
                <input type="hidden" id="txtPCId" value="" />
                <input type="hidden" id="txtPSId" value="" />
                <input type="hidden" id="txtPatientId" value="@ViewBag.patientId" />
                <input id="btnHisback" type="button" value="返回" class="l-button" style="height:26px;"/>
                <input id="btnTimeLine" type="button" value="时间轴" class="l-button" style="height:26px;" />
                <input id="btnTimePath" type="button" value="时间路径" class="l-button" style="height:26px;" />
                <input id="btnPrint" type="button" value="打印" class="l-button" style="height:26px;" />
                <input id="btnDel" type="button" value="删除" class="l-button" style="height:26px;" />
                <input id="btnSave" type="button" value="保存" class="l-button" style="height:26px;" />
                <input id="btnReview" type="button" value="审核" class="l-button" style="height:26px;display:none;" />
            </div>
        </div>
        <div style="height:100%;">
            <div class="lift-nav">
                <ul class="lift">
                    <li>基本信息</li>
                    <li>入院评估</li>
                    <li>体格检查</li>
                    <li>脑出血检查</li>
                    <li>脑出血手术</li>
                    <li>住院药物治疗</li>
                    <li>烟雾病登记</li>
                    <li>颅内AVM</li>
                    <li>康复治疗</li>
                    <li>健康教育</li>
                    <li>出院情况</li>
                </ul>
            </div>
            <div class="lift-target">
                <div class="t0" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>基本信息</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">姓名：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtrealName" name="txtrealName" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    性别：
                                    <label><input class="l-radio" type="radio" id="rdogender1" name="rdogender" value="1" />男</label>
                                    <label><input class="l-radio" type="radio" id="rdogender0" name="rdogender" value="0" />女</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    民族： <input type="text" id="txtethnic" name="txtethnic" class="l-text" />
                                </div>

                            </td>
                        </tr>
                        <tr style="height:35px;">
                            <td style="width:130px; text-align: right;">身份证：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtIDcard" name="txtIDcard" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    住院时间： <input type="text" id="txtlivePtime" name="txtlivePtime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">住院号：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtlivePid" name="txtlivePid" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    病人编号： <input type="text" id="txtpatId" name="txtpatId" class="l-text" readonly="readonly" />
                                </div> <div style="float:left;height:35px;line-height:35px;margin-left:27px;display:none;">
                                    病案号： <input type="text" id="txtpataId" name="txtpataId" class="l-text" readonly="readonly" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:120px; text-align: right;">医疗付款方式：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance0" name="chkmedicalinsurance" value="0" />城镇职工基本医疗保险</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance1" name="chkmedicalinsurance" value="1" />城镇居民基本医疗保险</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance2" name="chkmedicalinsurance" value="2" />新型农村合作医疗</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance3" name="chkmedicalinsurance" value="3" />贫困救助</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:120px; text-align: right;">&nbsp;</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance4" name="chkmedicalinsurance" value="4" />商业医疗保险</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance5" name="chkmedicalinsurance" value="5" />全公费</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance6" name="chkmedicalinsurance" value="6" />全自费</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance7" name="chkmedicalinsurance" value="7" />其他社会保险</label>
                                    <label><input type="radio" class="l-radio" id="chkmedicalinsurance8" name="chkmedicalinsurance" value="8" />其他</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">住院次数：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtlivePcount" name="txtlivePcount" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    发病：
                                    <label><input type="radio" class="l-radio" name="rdoillshow" id="rdoillshow0" value="0" />已知</label>
                                    <label><input type="radio" class="l-radio" name="rdoillshow" id="rdoillshow1" value="1" />未知</label>
                                    <label><input type="radio" class="l-radio" name="rdoillshow" id="rdoillshow2" value="2" />醒后卒中</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    发病时间： <input type="text" id="txtilltime" name="txtilltime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">是否在院卒中：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoisinhospill" id="rdoisinhospill1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdoisinhospill" id="rdoisinhospill0" value="0" />否</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    到院时间： <input type="text" id="txtcomedTime" name="txtcomedTime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">来院方式：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdocomeType" id="rdocomeType0" value="0" />本院急救车</label>
                                    <label><input type="radio" class="l-radio" name="rdocomeType" id="rdocomeType1" value="1" />当地120</label>
                                    <label><input type="radio" class="l-radio" name="rdocomeType" id="rdocomeType2" value="2" />外院转院</label>
                                    <label><input type="radio" class="l-radio" name="rdocomeType" id="rdocomeType3" value="3" />自行来院</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">入院途径：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;margin-left:0px;">
                                    <label><input class="l-radio" type="radio" name="rdocomeinType" id="rdocomeinType0" value="0" />急诊</label>
                                    <label><input class="l-radio" type="radio" name="rdocomeinType" id="rdocomeinType1" value="1" />门诊</label>
                                    <label><input class="l-radio" type="radio" name="rdocomeinType" id="rdocomeinType2" value="2" />其他医疗机构转入</label>
                                    <label><input class="l-radio" type="radio" name="rdocomeinType" id="rdocomeinType3" value="3" />其他</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t1" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>入院评估</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">入院mRS评分：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label> <input class="l-radio" type="radio" name="rdocomeinismRs" id="comeinismRs1" value="1" />已评</label>
                                    <label> <input class="l-radio" type="radio" name="rdocomeinismRs" id="comeinismRs0" value="0" />未评</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;" id="rdocomeinismRsYes">
                                    评分分数： <input type="text" id="txtcomeinmRs" name="txtcomeinmRs" class="l-text" />
                                </div>

                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">入院GCS评分：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label> <input class="l-radio" type="radio" name="rdocomeinisGcs" id="rdocomeinisGcs1" value="1" />已评</label>
                                    <label> <input class="l-radio" type="radio" name="rdocomeinisGcs" id="rdocomeinisGcs0" value="0" />未评</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;" id="rdocomeinisGcsYes">
                                    评分分数： <input type="text" id="txtcomeinGcs" name="txtcomeinGcs" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">吞咽功能评估：</td>

                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdotygnpgischk" id="rdotygnpgischk1" value="1" />已评</label>
                                    <label><input type="radio" class="l-radio" name="rdotygnpgischk" id="rdotygnpgischk0" value="0" />未评</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    是否脑疝：
                                    <label> <input type="radio" class="l-radio" name="rdocomeinisns" id="rdocomeinisns1" value="1" />是</label>
                                    <label> <input type="radio" class="l-radio" name="rdocomeinisns" id="rdocomeinisns0" value="0" />否</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    洼田饮水实验： <input type="text" id="txtwtyssyVal" name="txtwtyssyVal" class="l-text" />
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t2" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>体格检查</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">身高(cm)：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtpheigh" name="txtpheigh" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    体重(kg)： <input type="text" id="txtpweight" name="txtpweight" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    BMI(kg/㎡)： <input type="text" id="txtbmiVal" name="txtbmiVal" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">收缩压(mmHg)：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtpssyVal" name="txtpssyVal" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    舒张压(mmHg)： <input type="text" id="txtpszyVal" name="txtpszyVal" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    脉搏(次/分)： <input type="text" id="txtpmbVal" name="txtpmbVal" class="l-text" />
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t3" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>脑出血检查</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">出血部位左侧：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycl" id="cbxncxchkbodycl0" value="0" />基底节区</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycl" id="cbxncxchkbodycl1" value="1" />幕上脑叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycl" id="cbxncxchkbodycl2" value="2" />小脑</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycl" id="cbxncxchkbodycl3" value="3" />脑干</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycl" id="cbxncxchkbodycl4" value="4" />脑室</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">出血部位右侧：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycr" id="cbxncxchkbodycr0" value="0" />基底节区</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycr" id="cbxncxchkbodycr1" value="1" />幕上脑叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycr" id="cbxncxchkbodycr2" value="2" />小脑</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycr" id="cbxncxchkbodycr3" value="3" />脑干</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxchkbodycr" id="cbxncxchkbodycr4" value="4" />脑室</label>
                                </div>

                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">出血量(ml)：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtncxcxlmg" name="txtncxcxlmg" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    颅内血管检查：
                                    <label><input type="checkbox" class="l-checkbox" name="cbxcomeinlnxgchk" id="cbxcomeinlnxgchk0" value="0" />CTA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxcomeinlnxgchk" id="cbxcomeinlnxgchk1" value="1" />MRA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxcomeinlnxgchk" id="cbxcomeinlnxgchk2" value="2" />DSA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxcomeinlnxgchk" id="cbxcomeinlnxgchk3" value="3" />未查</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">病因诊断：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk0" value="0" />高血压</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk1" value="1" />动静脉畸形AVM</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk2" value="2" />烟雾病</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk3" value="3" />血管淀粉样变性</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk4" value="4" />颅内动脉瘤</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk5" value="5" />硬脑膜动静脉痿</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk6" value="6" />海绵状血管瘤</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk7" value="7" />颅内动静脉窦血栓形成</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxillreasonchk" id="cbxncxillreasonchk8" value="8" />其他</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t4" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>脑出血手术</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">手术开始时间：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtncxssstartTime" name="txtncxssstartTime" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    发病到开始手术时间(分)：
                                    <input type="text" id="txtstartilltossMin" name="txtstartilltossMin" class="l-text" style="width:40px;" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    到院到开始手术时间(分)：
                                    <input type="text" id="txtstarthosptossMin" name="txtstarthosptossMin" class="l-text" style="width:40px;" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">麻醉方式：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoncxssfullmType" id="rdocbxncxssfullmType1" value="0" />全麻</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxssfullmType" id="rdocbxncxssfullmType2" value="1" />局麻</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">手术方式：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType0" value="0" />开颅血肿清除术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType1" value="1" />去骨瓣减压术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType2" value="2" />脑室镜下血肿抽吸术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType3" value="3" />钻孔血肿抽吸术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType4" value="4" />颅内动脉瘤</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">&nbsp;</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType5" value="5" />硬脑膜动静脉痿</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType6" value="6" />复合手术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopType" id="cbxncxssopType7" value="7" />其他</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">脑部并发症：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz0" value="0" />手术部位再次脑出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz1" value="1" />手术远隔部位再出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz2" value="2" />脑梗死</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz3" value="3" />继发性癫痫</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz4" value="4" />颅内感染</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz5" value="5" />其他</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxssopbfz" id="cbxncxssopbfz6" value="6" />无</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">预后：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoncxssopEnd" id="rdoncxssopEnd0" value="0" />治愈</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxssopEnd" id="rdoncxssopEnd1" value="1" />好转</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxssopEnd" id="rdoncxssopEnd2" value="2" />加重</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxssopEnd" id="rdoncxssopEnd3" value="3" />死亡</label>
                                </div>
                            </td>
                        </tr>


                    </table>
                </div>

                <div class="t5" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>住院药物治疗</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">降压：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdonxcliveisjyyw" id="rdonxcliveisjyyw1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdonxcliveisjyyw" id="rdonxcliveisjyyw0" value="0" />否</label>
                                </div>
                                <div style="float: left; height: 35px; line-height: 35px; margin-left: 27px; " id="rdonxcliveisjyywYes">
                                    药物种类：
                                    <label><input type="checkbox" class="l-checkbox" name="cbxnxclivepjyy" id="cbxnxclivepjyy0" value="0" />ACEI</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxnxclivepjyy" id="cbxnxclivepjyy1" value="1" />ARB</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxnxclivepjyy" id="cbxnxclivepjyy2" value="2" />利尿剂</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxnxclivepjyy" id="cbxnxclivepjyy3" value="3" />β受体阻滞剂</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxnxclivepjyy" id="cbxnxclivepjyy4" value="4" />钙拮抗剂</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxnxclivepjyy" id="cbxnxclivepjyy5" value="5" />其他</label>
                                </div>

                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">调脂：</td>
                            <td>
                                <div style="float: left; height: 35px; line-height: 35px; ">
                                    <label><input type="radio" class="l-radio" name="rdonxcliveistzyw" id="rdonxcliveistzyw1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdonxcliveistzyw" id="rdonxcliveistzyw0" value="0" />否</label>
                                </div>
                                <div style="float: left; height: 35px; line-height: 35px; margin-left: 27px; ">
                                    降糖：
                                    <label><input type="radio" class="l-radio" name="rdonxcliveisjtyw" id="rdonxcliveisjtyw1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdonxcliveisjtyw" id="rdonxcliveisjtyw0" value="0" />否</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t6" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>烟雾病登记</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">临床表现类型：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType0" value="0" />TIA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType1" value="1" />脑梗塞</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType2" value="2" />脑室出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType3" value="3" />蛛网膜下腔出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType4" value="4" />头痛</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType5" value="5" />癫痫发作</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywblcbxType" id="cbxywblcbxType6" value="6" />其他</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">既往是否有类似病史：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoywbhishavelikes" id="rdoywbhishavelikes1" value="1" />有</label>
                                    <label><input type="radio" class="l-radio" name="rdoywbhishavelikes" id="rdoywbhishavelikes0" value="0" />无</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    上次发病时间：
                                    <input type="text" id="txtywbpreshowillTime" name="txtywbpreshowillTime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">既往手术情况：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoywbhisishssqk" id="ywbhisishssqk1" value="1" />有</label>
                                    <label><input type="radio" class="l-radio" name="rdoywbhisishssqk" id="ywbhisishssqk0" value="0" />无</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    烟雾状血管位置：
                                    <label><input type="radio" class="l-radio" name="rdoywbxglocation" id="rdoywbxglocation0" value="0" />左侧</label>
                                    <label><input type="radio" class="l-radio" name="rdoywbxglocation" id="rdoywbxglocation1" value="1" />右侧</label>
                                    <label><input type="radio" class="l-radio" name="rdoywbxglocation" id="rdoywbxglocation2" value="2" />双侧</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">烟雾状血管位置情况：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbxglocationinfo" id="cbxywbxglocationinfo0" value="0" />大脑动脉ACA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbxglocationinfo" id="cbxywbxglocationinfo1" value="1" />大脑中动脉MCA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbxglocationinfo" id="cbxywbxglocationinfo2" value="2" />大脑后动脉PCA</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbxglocationinfo" id="cbxywbxglocationinfo3" value="3" />其他</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">颅内外是否有代偿：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoywblinoutishavedc" id="rdoywblinoutishavedc1" value="1" />有</label>
                                    <label><input type="radio" class="l-radio" name="rdoywblinoutishavedc" id="rdoywblinoutishavedc0" value="0" />无</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    烟雾病发病本次是否手术治疗：
                                    <label><input type="radio" class="l-radio" name="rdoywbshowillishavetok" id="rdoywbshowillishavetok1" value="1" />有</label>
                                    <label><input type="radio" class="l-radio" name="rdoywbshowillishavetok" id="rdoywbshowillishavetok0" value="0" />无</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    手术开始时间：
                                    <input type="text" id="txtywbstartssTime" name="txtywbstartssTime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">治疗方式：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbfullType" id="cbxywbfullType0" value="0" />STM/MTA搭桥</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbfullType" id="cbxywbfullType1" value="1" />STA贴敷</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbfullType" id="cbxywbfullType2" value="2" />颞肌贴敷</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbfullType" id="cbxywbfullType3" value="3" />硬脑膜贴敷</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbfullType" id="cbxywbfullType4" value="4" />其他</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">手术治疗并发症：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbssfullbfz" id="cbxywbssfullbfz0" value="0">出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbssfullbfz" id="cbxywbssfullbfz1" value="1">梗塞</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbssfullbfz" id="cbxywbssfullbfz2" value="2">继发性癫痫</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbssfullbfz" id="cbxywbssfullbfz3" value="3">感染</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbssfullbfz" id="cbxywbssfullbfz4" value="4">其他</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxywbssfullbfz" id="cbxywbssfullbfz5" value="5" />无</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t7" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>颅内AVM登记</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">AVM类型：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoavmType" id="rdoavmType0" value="0" />脑实质AVM</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmType" id="rdoavmType1" value="1" />脑膜脑AVM</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    AVM大小：
                                    <label><input type="radio" class="l-radio" name="rdoavmSize" id="rdoavmSize0" value="0" />小于3cm(1分)</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmSize" id="rdoavmSize1" value="1" />3-6cm(2分)</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmSize" id="rdoavmSize2" value="2" />大于6cm(3分)</label>
                                </div>
                            </td>
                        </tr>

                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">AVM部位特征：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoavmbodyattr" id="rdoavmbodyattr0" value="0" />大脑非功能区</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmbodyattr" id="rdoavmbodyattr1" value="1" />大脑功能区</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    静脉引流位置：
                                    <label><input type="radio" class="l-radio" name="rdoavmjmylocation" id="rdoavmjmylocation0" value="0" />浅表部</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmjmylocation" id="rdoavmjmylocation1" value="1" />深部</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">Spetzler-Marin评分：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtspetzlerMarinVal" name="txtspetzlerMarinVal" class="l-text" />
                                </div>
                            </td>
                        </tr>

                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">有无静脉血栓：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoavmishavejmxs" id="rdoavmishavejmxs1" value="1" />有</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmishavejmxs" id="rdoavmishavejmxs0" value="0" />无</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    是否手术治疗：
                                    <label><input type="radio" class="l-radio" name="rdoavmjmxsissszl" id="rdoavmjmxsissszl1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdoavmjmxsissszl" id="rdoavmjmxsissszl0" value="0" />否</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    AVM治疗时间：
                                    <input type="text" id="txtavmsszlTime" name="txtavmsszlTime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">AVM治疗策略：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlType" id="cbxavmsszlType0" value="0" />栓塞术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlType" id="cbxavmsszlType1" value="1" />血肿清除术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlType" id="cbxavmsszlType2" value="2" />AVM切除术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlType" id="cbxavmsszlType3" value="3" />放射外科手术</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlType" id="cbxavmsszlType4" value="4" />复合手术</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">治疗并发症：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlbfz" id="avmsszlbfz0" value="0" />颅内出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlbfz" id="avmsszlbfz1" value="1" />脑梗死</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlbfz" id="avmsszlbfz2" value="2" />其他</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmsszlbfz" id="avmsszlbfz3" value="3" />无</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">AVM责任病灶 左侧：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzL" id="cbxavmzrbzL0" value="0" />额叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzL" id="cbxavmzrbzL1" value="1" />顶叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzL" id="cbxavmzrbzL2" value="2" />颞叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzL" id="cbxavmzrbzL3" value="3" />枕叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzL" id="cbxavmzrbzL4" value="4" />小脑</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzL" id="cbxavmzrbzL5" value="5" />深部</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">AVM责任病灶 右侧：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzR" id="cbxavmzrbzR0" value="0" />额叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzR" id="cbxavmzrbzR1" value="1" />顶叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzR" id="cbxavmzrbzR2" value="2" />颞叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzR" id="cbxavmzrbzR3" value="3" />枕叶</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzR" id="cbxavmzrbzR4" value="4" />小脑</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzR" id="cbxavmzrbzR5" value="5" />深部</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">AVM责任病灶 中部：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzC" id="cbxavmzrbzC0" value="0" />脑干</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzC" id="cbxavmzrbzC1" value="1" />胼胝体</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxavmzrbzC" id="cbxavmzrbzC2" value="2" />其他</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>
                <div class="t8" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>康复治疗</h3>
                                <hr />
                            </td>
                        </tr>

                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">接受康复治疗：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoncxiskfzl" id="rdoncxiskfzl1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxiskfzl" id="rdoncxiskfzl0" value="0" />否</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;" id="rdoncxiskfzlYes1">
                            <td style="width:130px; text-align: right;">康复治疗方式：</td>
                            <td>
                                <div style="float: left; height: 35px; line-height: 35px; ">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlType" id="ncxkfzlType0" value="0" />传统康复(针灸/推拿)</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlType" id="ncxkfzlType1" value="1" />运动疗法(PT)</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlType" id="ncxkfzlType2" value="2" />作业疗法(OT)</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;" id="rdoncxiskfzlYes2">
                            <td style="width:130px; text-align: right;">&nbsp;</td>
                            <td>
                                <div style="float: left; height: 35px; line-height: 35px; ">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlType" id="ncxkfzlType3" value="3" />言语训练(ST)</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlType" id="ncxkfzlType4" value="4" />其他(认知训练/吞咽治疗/心理治疗/理疗)</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;" id="rdoncxiskfzlYes3">
                            <td style="width:130px; text-align: right;">康复治疗场所：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlAddr" id="cbxncxkfzlAddr0" value="0" />床旁</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxkfzlAddr" id="cbxncxkfzlAddr1" value="1" />康复科</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t9" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>健康教育</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">健康宣教：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoncxheathisxj" id="rdoncxheathisxj1" value="1" />是</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxheathisxj" id="rdoncxheathisxj0" value="0" />否</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;" id="rdoncxheathisxjYes">
                                    宣教方式：
                                    <label><input type="checkbox" class="l-checkbox" name="rdoncxheathxjType" id="rdoncxheathxjType0" value="0" />集体病区教育</label>
                                    <label><input type="checkbox" class="l-checkbox" name="rdoncxheathxjType" id="rdoncxheathxjType1" value="1" />一对一教育</label>
                                    <label><input type="checkbox" class="l-checkbox" name="rdoncxheathxjType" id="rdoncxheathxjType2" value="2" />其他</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>

                <div class="t10" style="margin-top:55px;">
                    <table style="width: 100%;">
                        <tr style="height: 35px;">
                            <td colspan="2" style="text-align: center;">
                                <h3>出院情况</h3>
                                <hr />
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">出院时间：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtncxexitPtime" name="txtncxexitPtime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">离院方式：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoncxexitPType" id="rdoncxexitPType0" value="0" />医嘱离院</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxexitPType" id="rdoncxexitPType1" value="1" />医嘱转院</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxexitPType" id="rdoncxexitPType2" value="2" />医嘱转社区服务机构/乡镇卫生院</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxexitPType" id="rdoncxexitPType3" value="3" />非医嘱离院</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxexitPType" id="rdoncxexitPType4" value="4" />死亡</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxexitPType" id="rdoncxexitPType5" value="5" />其他</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;" id="rdoncxexitPTypeYes1">
                            <td style="width:130px; text-align: right;">死亡时间：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <input type="text" id="txtncxdieTime" name="txtncxdieTime" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;" id="rdoncxexitPTypeYes2">
                            <td style="width:130px; text-align: right;">死亡原因：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason0" value="0" />呼吸循环衰竭</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason1" value="1" />脑血管病</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason2" value="2" />肺部感染</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason3" value="3" />上消化道出血</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason4" value="4" />急性肾功能衰竭</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;" id="rdoncxexitPTypeYes3">
                            <td style="width:130px; text-align: right;">&nbsp;</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason5" value="5" />损伤和中毒</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason6" value="6" />其他</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxdieReason" id="cbxncxdieReason7" value="7" />不详</label>
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">出院时mRS评分：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="radio" class="l-radio" name="rdoncxleavehospismRs" id="rdoncxleavehospismRs1" value="1" />已评</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxleavehospismRs" id="rdoncxleavehospismRs0" value="0" />未评</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;" id="divncxleavehospismRsScore">
                                    评分分数： <input type="text" id="txtHospital_MRS_Score" name="txtHospital_MRS_Score" class="l-text" />
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;">
                                    出院时GCS评分：
                                    <label><input type="radio" class="l-radio" name="rdoncxexitisGcs" id="rdoncxexitisGcs1" value="1" />已评</label>
                                    <label><input type="radio" class="l-radio" name="rdoncxexitisGcs" id="rdoncxexitisGcs0" value="0" />未评</label>
                                </div>
                                <div style="float:left;height:35px;line-height:35px;margin-left:27px;" id="divncxexitisGcsScore">
                                    评分分数： <input type="text" id="txtHospital_GCS_Score" name="txtHospital_GCS_Score" class="l-text" />
                                </div>
                            </td>
                        </tr>
                        <tr style="height: 35px;">
                            <td style="width:130px; text-align: right;">出院带药：</td>
                            <td>
                                <div style="float:left;height:35px;line-height:35px;">
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy0" value="0" />降压药</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy1" value="1" />降糖药</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy2" value="2" />调脂药</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy3" value="3" />抗凝药</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy4" value="4" />抗血小板药</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy5" value="5" />中药治疗</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy6" value="6" />其他</label>
                                    <label><input type="checkbox" class="l-checkbox" name="cbxncxexitpwithy" id="cbxncxexitpwithy7" value="7" />无</label>
                                </div>
                            </td>
                        </tr>
                    </table>
                </div>
            </div>
        </div>
    </form>
</body>
</html>